Beyond the breast

By Melissa EricksonMore Content Now

Thursday

Sep 15, 2016 at 12:14 PMSep 15, 2016 at 12:14 PM

Living with metastatic breast cancer is like running a marathon, says Dr. Mariana Chavez MacGregor, assistant professor of breast medical oncology at the University of Texas MD Anderson Cancer Center. There is no cure for metastatic breast cancer, but you have to concentrate on the fact that you’re still running, you’re still in the race.“Metastatic breast cancer is treatable but can’t be cured,” said Shirley Mertz, president, Metastatic Breast Cancer Network. “Although it varies by subtype, median survival is two to three years.”What it isAlso known as Stage IV breast cancer, metastatic breast cancer refers to cancer that has spread outside of the breast in which it originated and outside of the lymph nodes and mammary glands. “If it stays within the breast, if that’s the extent of it, it’s Stage I, II or III breast cancer,” said Dr. Keerthi Gogineni, breast oncologist at the Winship Cancer Institute of Emory University. “If it goes outside that zone, to lymph nodes further away — lymph nodes in the groin, to the bone, liver, lungs, brain, even the skin – it’s Stage IV breast cancer. “It’s not limited to cancer in what we consider important organs. It could be in the bones, which we don’t think of as critical organs.” Treatment of metastatic breast cancer is a hot topic as oncologists and others in the field seek to maximize both length and quality of life for women and men living with Stage IV breast cancer.“As a general rule with few exceptions, metastatic breast cancer is incurable. While you can live significantly longer, you will die of breast cancer. The goal is to live longer and preserve quality of life,” MacGregor said.“Some types of metastatic cancer can be cured with current treatments. Lance Armstrong had metastatic testicular cancer, and we can say that he is cured, but metastatic breast cancer is incurable in 2016. Although it can’t be cured, it can be treated,” said Mertz.While doctors can’t offer a cure, “the cancer can be very well controlled and you can live for years,” Gogineni said.‘Very treatable disease’Different subtypes of metastatic breast cancer respond better to different treatments. “The tools are different for each. You have to take into account the symptoms, the goals of care, the support at home,” MacGregor said.“The main thing is to control the cancer, to shrink the cancer where we know it exists and keep it from taking root in different parts of the body, to balance the side effects of treatment and improve quality of life,” Gogineni said. “I tell my patients it’s a very treatable disease.” While other forms of breast cancer can be influenced by early detection, metastatic breast cancer presents a tough question. “There’s no proof that identifying metastatic breast cancer earlier before symptoms appear actually changes the treatment or the effectiveness of the treatment,” Gogineni said. “It’s hard for people to understand.” “Mammograms are important, but early detection is not a breast cancer cure. In fact, most of the 155,000 U.S. people currently living with metastatic breast cancer were originally treated for early stage breast cancer? — ?their cancer came back five, 10, 15 and even 17 years later? — ?even though they took excellent care of themselves and had regular mammograms,” said Mertz, who was diagnosed with metastatic breast cancer in 2003. “It would be wrong to say that mammography doesn’t save lives. But as the American Cancer Society’s Otis Brawley said, we need to use it with caution, explain its limitations and realize that we need a better test.” Men and women living with metastatic breast cancer should be vigilant rather than paranoid, Gogineni said. If a health issue doesn’t resolve itself normally – for example, a sore back from working in the yard lingers longer than expected or a seasonal illness knocks you down for longer than normal – see your doctor. “Follow up on what’s not normal,” Gogineni said. “Be an advocate for yourself.” As years pass and you’re back to seeing your primary care doctor or gynecologist, “remind your team if something starts brewing. Be sure to say, ‘I have a history of breast cancer,’” Gogineni said.

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